Autism and Communication (cont.)

Roxanne Dryden-Edwards, MD

Dr. Roxanne Dryden-Edwards is an adult, child, and adolescent psychiatrist. She is a former Chair of the Committee on Developmental Disabilities for the American Psychiatric Association, Assistant Professor of Psychiatry at Johns Hopkins Hospital in Baltimore, Maryland, and Medical Director of the National Center for Children and Families in Bethesda, Maryland.

William C. Shiel Jr., MD, FACP, FACR

Dr. Shiel received a Bachelor of Science degree with honors from the University of Notre Dame. There he was involved in research in radiation biology and received the Huisking Scholarship. After graduating from St. Louis University School of Medicine, he completed his Internal Medicine residency and Rheumatology fellowship at the University of California, Irvine. He is board-certified in Internal Medicine and Rheumatology.

How is autism treated in children and adults?

Misinformation about autism is very common. Claims of a cure for autism are
constantly presented to families of individuals with autism. There are various
treatment models found within both the educational and clinical settings.

What common sociobehavioral interventions are used to treat autism?

There is only one treatment approach that has prevailed over time and is effective for all persons, with or without autism. That treatment model is an educational (school or vocational) program that is suitable to a student's developmental level of performance. One such program is the Son-Rise Program. For adults, that treatment model refers to a vocational program that is suitable to the individual's developmental level of functioning.

Under the federal law, the Individuals with Disabilities Educational Act (IDEA) Act of 1990, students with a handicap are guaranteed an "appropriate education" in the Least Restrictive Environment (LRE), which is generally considered to be as normal an educational setting as possible. As a result of this legislation, children with autism have often been placed in a mainstreamed classroom and pulled out for whatever supplementary services were needed. Depending on the child's needs, he or she could be placed up to 100% of the school day in a mainstreamed or a special education setting or any combination of the two in order to receive the most appropriate help possible.

There is an increasing trend, however, in advocacy for children with autism, to segregate these children into small, highly structured and controlled academic and vocational training programs that are almost free from auditory and visual stimulation. All instruction is broken down into manageable segments. Information is presented in tiny units and the child's response is immediately sought. A classic stimulus-response approach is used to maximize learning. Each unit of information is mastered before another is presented. A fundamental behavior such as putting hands on the tabletop, for example, must be mastered before the child is required to perform any other tasks, or before more information is presented. The long-term effects of this type of treatment as well as the ability of the child to transfer this to a broader context continue to be evaluated. For people with autism whose symptoms include self injurious behaviors, the focus of treatment has shifted from restriction and punishment to more of a focus on understanding potential motivators for negative behaviors, as well as rewards and other encouragement and support for using appropriate behaviors.

Children, teens, and adults with autism need to be taught how to communicate and interact with others. This is not a simple task, and it involves the entire family as well as other professionals. Parents of a child or adult with autism must continually educate themselves about new therapies and keep an open mind. Some treatments may be appropriate for some individuals but not for others. Many treatments have yet to be scientifically proven. Treatment decisions should always be made individually after a thorough assessment and based on what is suitable for that person and his or her family.

It is important to remember, despite some recent denials, that autism is usually a lifelong condition. The kind of support that is appropriate will change as the individual develops. Families must beware of treatment programs that give false hope of a cure. Acceptance of the condition in a family member is a very critical, foundational component of any treatment program and is understandably quite difficult.

Psychotherapeutic approaches that have been found to help improve functioning in some persons with autism include comprehensive behavioral therapy to address problematic behaviors. Social skills training and support are important in helping people with autism navigate interactions with others, since many of this population crave social interaction despite their limitations in engaging others socially. Cognitive behavioral treatment in verbal individuals with anxiety and voice output communication who are less verbal are considered promising areas of treatment as well.